Patients with obstructive sleep apnea (OSA) who received positive airway pressure therapy had greater improvements in blood pressure compared with those who received upper airway stimulation, according to the results of a study published in CHEST.

Blood pressure and Epworth Sleepiness Scale (ESS) measurements from patients with OSA were taken during clinical visits both before and after treatment with either positive airway pressure or upper airway stimulation. Changes in blood pressure and ESS scores were then compared between groups.

Of the 517 patients with obstructive sleep apnea enrolled in the study, after propensity matching, 201 patients each received 1 of 2 treatment options. Positive airway pressure showed greater improvement in diastolic blood pressure (mean, 77.0 mm Hg [95% CI, 75.3-78.7 mm Hg] to 74.6 mm Hg [95% CI, 72.9-76.4 mm Hg]) and mean arterial pressure (94.7 mm Hg [95% CI, 92.9-96.5 mm Hg] to 92.5 mm Hg [95% CI, 90.6-94.3 mm Hg]) compared with upper airway stimulation. Although both treatment groups experienced improvements in ESS scores, the improvement was more significant in the upper airway stimulation group vs the positive airway pressure group (-3.5 vs -2.7; difference in means -0.8; P =.046).

One limitation of this study is the fact that the nonstandard approaches were used to measure blood pressure in the clinic-based upper airway stimulation registry, which may have contributed to measurement error. As a result, the researchers stated that the findings should not be considered definitive and should be interpreted with caution. In addition, the retrospective design and lack of complete antihypertensive therapy may have affected the results.

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“[Positive airway pressure] showed greater improvement in [blood pressure], potentially reflecting enhanced ability of [positive airway pressure] to exert beneficial mechanical intrathoracic cardiac and vascular influences,” the researchers wrote. “[Blood pressure] measurement error in the [upper airway stimulation] group may also have accounted for findings.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Walia H, Thompson N, Strohl K, et al. Upper airway stimulation versus positive airway pressure impact on blood pressure and sleepiness symptoms in obstructive sleep apnea [published online July 9, 2019]. CHEST. doi:10.1016/j.chest.2019.06.020