Does the Treatment of Obstructive Sleep Apnea and Obesity Improve Pulsatile Hemodynamics?
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See related article, pp 1283–1290
During the last few decades, our view of blood pressure (BP) in the scientific community has evolved. Instead of focusing on the upper and lower extremes of BP (ie, systolic and diastolic BP) only, we now consider the entire BP curve and, with the help of advanced technology, derive information on underlying vascular properties. BP has a steady component, its level, and a pulsatile component, the fluctuations around this level. Apart from cardiac function, which is obviously one of the major contributors to both BP components, the steady component (mean BP) is related to peripheral resistance, whereas the pulsatile component (pulse pressure) is mainly related to large arterial and aortic function. Popular measurements of pulsatile function are aortic stiffness (aortic or carotid–femoral pulse wave velocity), indices of wave reflections, and central systolic BP and pulse pressure, which are different from peripheral (brachial) BP measurements, with the difference between central and peripheral BP levels (amplification) being dependent on arterial function. A rapidly increasing number of clinical trials performed in the past 20 years have provided evidence that pulsatile hemodynamics (pulse wave velocity,1 wave reflections,2 and central BP measurements3) are independent predictors of clinical outcomes, with the most compelling evidence for pulse wave velocity.4
Against this background, Jain et al5 investigated the effect of continuous positive airway pressure (CPAP) therapy, weight loss, and …