Continuous Monitoring Nocturnal Beat-to-beat Blood Pressure Fluctuation in OSA With or Without Hypertension
28 mars 2017 uppdaterad av: Xu J, Huai'an No.1 People's Hospital
Huai'an First People's Hospital,Nanjing Medical University
Emerging evidence suggests that there is a causal link between obstructive sleep apnea(OSA) and hypertension.
Patient with this syndrome exhibit several characteristics: high prevalence, frequent non-dipper status, diastolic and nocturnal predominance, which are related to clinical and subclinical organ damage in heart and brain.
However, the influence of OSA on nocturnal hypertension development has not yet been clarified.
Blood pressure variability (BPV) plays a role in vascular damage, independent of blood pressure.
Apnea overloads the autonomic cardiovascular control system and may influence BPV,which is classified by different time interval, including beat-to-beat, hour-to-hour day-to-night changes or long-term, for example days, weeks, months, seasons, and even years.
All BPV abnormalities are associated with an increased incidence of cardiovascular events and mortality.
The investigators pre-experiment estimate BPV by ambulatory blood pressure monitoring (ABPM), which unable to capture the BP fluctuation accurately during the apnea event.
The small studies exam beat-to-beat BP and OSA，and the investigators can't couple the events with blood fluctuation, also incapable calculate the correlation of them.
This study is aimed to use pulse transmit time(PTT) based blood pressure measurement which can be useful for continuous monitoring of blood pressure to monitor nocturnal beat-to-beat blood pressure fluctuation in OSA with or without hypertension, investigating the degree of relevance between hypoxia, AHI, nocturnal hypertension development and BPV.
Besides that the investigators also evaluate the effect of continuous positive airway pressure(CPAP) on blood pressure and nocturnal beat-to-beat BPV.
Studieöversikt
Detaljerad beskrivning
Methods:
Between March 2016 and December 2016,the investigators initially recruited 450 individuals reporting severe habitual snoring. Primal evaluations including office blood pressure, Epworth Sleepiness Scale Score(ESS), antihypertensive medicine demographic and anthropometric data. Then overnight polysomnography were performed. Of them,100 were severe OSA (AHI>30 episode/h) with hypertension, who were agreed to stop taking antihypertensive medicine. The investigators calculated the time to stop based on the half-life of patients taking oral drugs and last time administration time. The subject who withdrawal time was less than three days was enrolled in this study. These patients were hospitalized and close monitoring of blood pressure, for blood pressure three times greater than 180/110mmHg or appearing dizziness, headache and other clinical syndrome, the investigators will give a timely clinical intervention and get rid of this study. The control group consisted of 100 subjects just with severe OSA whose blood pressure is normal. The investigators recorded nocturnal blood pressure, oximetry, beat-to-beat BPV, AHI, BP event was calculated. Screening of 40 newly diagnosed patients with hypertension and subjects with poor blood pressure control, the investigators would give one-night continuous positive airway pressure(CPAP) to compare the AHI, the mean nocturnal systolic blood pressure and diastolic blood pressure, the number of blood events before and after short-term CPAP therapy, to compare the AHI, the mean nocturnal systolic blood pressure and diastolic blood pressure, the number of blood events before and after short-term CPAP therapy.
Studietyp
Interventionell
Inskrivning (Faktisk)
198
Fas
- Inte tillämpbar
Kontakter och platser
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Studieorter
-
-
Jiangsu
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Huai'an, Jiangsu, Kina, 223300
- Department Of Respiratory Medicine,Huai'an First People's Hospital,Nanjing Medical University
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Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
18 år till 70 år (Vuxen, Äldre vuxen)
Tar emot friska volontärer
Nej
Kön som är behöriga för studier
Allt
Beskrivning
Inclusion Criteria:
- severity OSA (AHI>30 episode/h)
- aged between 18 to 70 yeas
- blood pressure≦180/110mmHg
Exclusion Criteria:
- blood pressure>180/110mmHg
- severe clinical events such as coronary artery disease, heart failure,cerebrovascular disease or renal failure
- diabetes
- patients with suspected secondary hypertension
- patients with pulmonary disease being treated with bronchodilators, corticosteroids, or oxygen
- individuals who are able to perform the test
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Icke-randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Inget ingripande: OSA group
100 severe OSA patients without hypertension were enrolled.
Primal evaluations including office blood pressure, Epworth sleepiness scale score(ESS),demographic and anthropometric data The full night polysomnogram was performed, recording nocturnal blood pressure, oximetry, beat-to-beat BPV, AHI, BP event was calculated
|
|
|
Övrig: OSA with hypertension
100 severe OSA patients with hypertension were enrolled.
Primal evaluations including office blood pressure, Epworth sleepiness scale score(ESS), antihypertensive medicine demographic and anthropometric data.
The full night polysomnogram was performed, recording nocturnal blood pressure, oximetry, beat-to-beat BPV, AHI, BP event was calculated.Screening of 40 newly diagnosed patients with hypertension and subjects with poor blood pressure control, the investigators would give one-night CPAP.
|
OSA complicated with hypertension：In order to avoid the effects of drugs on this study, we calculated the time to stop based on the half-life of patients taking oral drugs and last time administration time.
The subject who withdrawal time was less than three days was enrolled in our study.
These patients were hospitalized and close monitoring of blood pressure, for blood pressure three times greater than 180/110mmHg or appearing dizziness, headache and other clinical syndrome, we give a timely clinical intervention and get rid of our study.
Screening of 40 newly diagnosed patients with hypertension and subjects with poor blood control,the investigators would give one-night CPAP
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Office hypertension
Tidsram: 2 hours
|
as BP≧140/90mmHg on three different occasions (according to standard guidelines)
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2 hours
|
|
nocturnal hypertension
Tidsram: 1 night
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as nighttime systolic blood pressure ≧120mmHg and/or70mmHg(diastolic blood pressure) |
1 night
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hypoxemia
Tidsram: 1 night
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as the total time and the number of pulse oxygen less than 90% ,the minimum lowest pulse oxygen saturation during sleep
|
1 night
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Beat-to-Beat BPV
Tidsram: 1 night
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as the a increase in systolic blood pressure(SPB) from baseline during an apnea event
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1 night
|
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BP event
Tidsram: 1 night
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the number of beat-to-beat BPV>10mmHg divided by sleep time
|
1 night
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Apnea-hypopnea index(AHI)
Tidsram: 1 night
|
AHI was defined as the number of apnea plus hypopnea episode per hour of sleep and was the summary measurement of the occurrence of sleep -disordered breathing.Apnea was defined as a reduction of airflow of at least 90% on the oronasal thermistor for at least 10s(it was considered obstructive if respiratory effort was absent).Hypopneas was scored when the magnitude of the signal decreased by at least 30% of the baseline amplitude of the nasal pressure transducer for at least 10s and was associated with a 4% or greater drop in oxygen saturation,as measured by finger pulse oximetry.
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1 night
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time of event
Tidsram: 1 night
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as the total time of apnea and hypopnea during sleep
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1 night
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Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Sponsor
Utredare
- Studiestol: Zi Li Meng, Master, Huai'an first people's hospital
Publikationer och användbara länkar
Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.
Allmänna publikationer
- Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlof B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010 Mar 13;375(9718):895-905. doi: 10.1016/S0140-6736(10)60308-X.
- Steinhorst AP, Goncalves SC, Oliveira AT, Massierer D, Gus M, Fuchs SC, Moreira LB, Martinez D, Fuchs FD. Influence of sleep apnea severity on blood pressure variability of patients with hypertension. Sleep Breath. 2014 May;18(2):397-401. doi: 10.1007/s11325-013-0899-z. Epub 2013 Oct 3.
- Johansson JK, Niiranen TJ, Puukka PJ, Jula AM. Prognostic value of the variability in home-measured blood pressure and heart rate: the Finn-Home Study. Hypertension. 2012 Feb;59(2):212-8. doi: 10.1161/HYPERTENSIONAHA.111.178657. Epub 2012 Jan 3.
- Xu J, Ding N, Chen L, Zhang Y, Huang M, Wang Y, Meng Z, Zhang X. Inducers of post-apneic blood pressure fluctuation monitored by pulse transfer time measurement in obstructive sleep apnea varied with syndrome severity. Sleep Breath. 2019 Sep;23(3):769-776. doi: 10.1007/s11325-018-1770-z. Epub 2019 Jan 12.
- Xu J, Ding N, Zhang X, Wang N, Sun B, Zhang R, Xie X, Wan Z, Gu Y, Zhang S, Hong Y, Huang M, Meng Z. Nocturnal blood pressure fluctuation and associated influential factors in severe obstructive sleep apnea patients with hypertension. Sleep Breath. 2018 Dec;22(4):1045-1052. doi: 10.1007/s11325-018-1634-6. Epub 2018 Mar 9.
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart
1 mars 2016
Primärt slutförande (Faktisk)
27 mars 2017
Avslutad studie (Faktisk)
27 mars 2017
Studieregistreringsdatum
Först inskickad
10 augusti 2016
Först inskickad som uppfyllde QC-kriterierna
22 augusti 2016
Första postat (Uppskatta)
23 augusti 2016
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
29 mars 2017
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
28 mars 2017
Senast verifierad
1 mars 2017
Mer information
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Andra studie-ID-nummer
- Huaian1PH
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