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Aims: We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). Methods and results: Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea–hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by −3.9 ± 15.5/−2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by −3.0 ± 9.8/−2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin–angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders. Conclusion: In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA. Graphical Abstract [ABSTRACT FROM AUTHOR]

Summary: We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta‐blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta‐blocker was associated with lower systolic blood pressure, particularly in non‐obese middle‐aged males with hypertension. Conversely, the combination of a beta‐blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate–severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross‐sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted. [ABSTRACT FROM AUTHOR]

New European Union (EU) regulations state that untreated moderate to severe obstructive sleep apnea (OSA) coincident with excessive daytime sleepiness (EDS) constitutes a medical disorder leading to unfitness to drive. However, fitness to drive can be re‐established by successful treatment of OSA and EDS. The aim of the current study was to compare patients undergoing the certification process with those of an unselected OSA patient cohort. The study compared consecutive patients in the certification group (n = 132) with a representative group of OSA patients with a current driving license and an Apnea Hypopnea Index (AHI) ≥ 15 n/h (n = 790). The adherence to positive airway pressure (PAP) therapy and the change in EDS (Epworth Sleepiness Scale [ESS] score) with treatment were analysed. Patient characteristics and severity of sleep apnea did not differ significantly between groups (certification/reference group: BMI 30 ± 5/31 ± 5 kg/m2, AHI 33 ± 20/36 ± 20 n/hr, ESS 12 ± 6/11 ± 5). However, the certification group was oversampled with elderly drivers (70–85 years: 22% vs. 9%, p = 0.001). PAP compliance was higher in the certification group than in the reference group (PAP use ≥ 4 hr/night in 96% vs. 53%, p = 0.001) and mean ESS reduction was ‐8.0 (‐8.9 – ‐7.1) versus ‐4.0 (‐4.4 – ‐3.5), respectively (p < 0.001). Patients attending the fitness to drive evaluation reported almost complete adherence to continuous positive airway pressure (CPAP) and elimination of EDS symptoms. Besides possible baseline differences, this strong response may be explained by factors such as a selection process of elderly patients, a self‐rating component in the assessment of the treatment response and the threat of a driving license suspension. Our data suggest that an improved certification process with objective rather than subjective components, along with a reduced selection bias, is warranted. [ABSTRACT FROM AUTHOR]