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The association of sleep disturbances measures with blood pressure: is the time to explore novel measurements?
  1. Bharati Prasad1,
  2. Manuel Sánchez-de-la-Torre2,3
  1. 1Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
  3. 3Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
  1. Correspondence to Dr Manuel Sánchez-de-la-Torre, Hospital Arnau de Vilanova-Santa María, IRBLleida, CIBERES, Avda. Rovira Roure 80, 25198., Lleida, Spain; sanchezdelatorre{at}gmail.com

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Obstructive sleep apnea (OSA) is a chronic disease that affects more than 15% of the adult population and becomes more prevalent with age.1 Although multiple observational studies show that OSA is an independent risk factor for cardiovascular disease (CVD), the treatment of OSA with continuous positive airway pressure (CPAP) does not uniformly prevent CVD. Recent randomised clinical trials failed to demonstrate a role for CPAP treatment in secondary CVD prevention.2 3 Nevertheless, CPAP treatment affects cardiovascular outcomes positively in specific groups of OSA patients. For example, patients with resistant hypertension experience a significant reduction in 24-hour blood pressure with CPAP treatment.4 Notably, a secondary analysis of this study showed that CPAP treatment did not decrease blood pressure in at least 30% of patients with resistant hypertension, demonstrating that a more precise approach to patient selection is needed to improve the effectiveness of OSA treatment(s) in CVD prevention. Previous studies have explored novel approaches to identify OSA patients where CPAP treatment has significant antihypertensive effects. These studies have demonstrated a combination of specific biomarkers together with the clinical characterisation of circadian blood pressure patterns to be informative.5–7 In this context, the identification of new clinical variables that go beyond the apnea-hypopnea index (AHI), which fails to capture the complexity of OSA pathophysiology, may allow precise CVD risk stratification.

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