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Position paper on the management of patients with obstructive sleep apnea and hypertension: Joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on Obstructive Sleep Apnea

Parati, Gianfrancoa,b; Lombardi, Carolinab; Hedner, Janc; Bonsignore, Maria R.d; Grote, Ludgerc; Tkacova, Ruzenae; Levy, Patrickf; Riha, Renatag; Bassetti, Claudioh; Narkiewicz, Krzysztofi; Mancia, Giuseppea; McNicholas, Walter T.jon behalf of the EU COST ACTION B26 members

doi: 10.1097/HJH.0b013e328350e53b

This article is aimed at addressing the current state of the art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnea (OSA) in cardiovascular (particularly hypertensive) patients, as well as for the management of cardiovascular diseases (particularly arterial hypertension) in OSA patients. The present document is the result of the work done by a panel of experts participating in the European Union COST (COoperation in Scientific and Technological research) ACTION B26 on OSA, with the endorsement of the European Respiratory Society (ERS) and the European Society of Hypertension (ESH). These recommendations are particularly aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are at the same time aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

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aDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca

bDepartment of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy

cSleep Disorders Centre, Sahlgrenska University Hospital, Gothenburg, Sweden

dDepartment of Medicine, Pneumology, Physiology and Nutrition (DIMPEFINU), University of Palermo, Palermo, Italy

eDepartment of Respiratory Medicine and Tuberculosis, Faculty of Medicine, L. Pasteur Teaching Hospital, P.J. Safarik University, Kosice, Slovakia

fGrenoble University Hospital, CHU Michallon, Grenoble, France

gRoyal Infirmary of Edinburgh, Edinburgh, UK

hDepartment of Neurology, University Hospital (Inselspital), Bern, Switzerland

iDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland

jRespiratory Sleep Disorders Unit, St Vincent's University Hospital, Conway Research Institute, University College, Dublin, Ireland

Correspondence to Professor Gianfranco Parati, MD, FESC, S. Luca Hospital, Istituto Auxologico Italiano, Piazzale Brescia 20, Milan 20159, Italy. Tel: +39 02 619 112 949; fax: +39 02 619 112 956; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; AHI, apnea hypopnea index; AV, atrioventricular; BP, blood pressure; CHF, congestive heart failure; CPAP, continuous positive airway pressure; CSA, central sleep apnea; CVD, cardiovascular diseases; DBP, diastolic blood pressure; IL-8, interleukine-8; NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells; OSA, obstructive sleep apnea; OSAS, obstructive sleep apnea syndrome; RAAS, renin–angiotensin–aldosterone system; SBP, systolic blood pressure; SRBD, sleep-related breathing disorders; SVES, supraventricular extrasystoles; TNF-α, tumor necrosis factor-α

Received 27 December, 2011

Accepted 30 December, 2011

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© 2012 Lippincott Williams & Wilkins, Inc.